Chronic Lymphocytic Leukemia And Autoimmune Hemolytic Leukemia Treatment Of Relapsed And Refractory Chronic Lymphocytic Leukemia With Ibrutinib

Part I Chronic lymphocytic leukemia with autoimmune hemolytic anemiaObjectives: Autoimmune hemolytic anemia is a major complication of chronic lymphocytic leukemia/small lymphocytic lymphoma.At present,in China,there is no retrospective study on the factors associated with autoimmune hemolytic anemia and its influence on prognosis.This article mainly discusses the clinical features,treatment and prognosis of chronic lymphocytic leukemia/small lymphocytic lymphoma with autoimmune hemolytic anemia.Methods: This research retrospectively analyzes patients with chronic lymphocytic leukemia/small lymphocytic lymphoma hospitalized in Shanghai Ruijin Hospital affiliated to Shanghai Jiaotong University,School of Medicine from January 2008 to December 2017.We want to determine the prevalence of autoimmune hemolytic anemia in chronic lymphocytic leukemia/small lymphocytic lymphoma,to correlate autoimmune hemolytic anemia with clinical and biological features,and to describe the treatment and to explore the influence of autoimmune hemolytic anemia on prognosis.Results: This research includes 155 patients with chronic lymphocytic leukemia/small lymphocytic lymphoma,of which 9 have autoimmune hemolytic anemia,thus giving a prevalence of 5.8%.Autoimmune hemolytic anemia is associated with high urine β2 microglobulin level.Of the 9 patients,1 died of respiratory and cardiac failure before receiving treatment of autoimmune hemolytic anemia.8 were treated with corticosteroid +/-immunoglobulin,1 achieved complete respond,6 partial respond,and 1 failure.Comparing patients with and without autoimmune hemolytic anemia,there is no statistical difference in their overall survival.Calculated from diagnosis of autoimmune hemolytic anemia,the median overall survival of the 9 patients with autoimmune hemolytic anemia was 34 months.Conclusions: Autoimmune hemolytic anemia is a common complication in patients with chronic lymphocytic leukemia/small lymphocytic lymphoma.Elevated urine β2 microglobulin is associated with Chinese patients with secondary autoimmune hemolytic anemia.Glucocorticoid,as a first-line treatment,is effective for patients with autoimmune hemolytic anemia.Autoimmune hemolytic anemia has no significant effect on the prognosis of Chinese patients with chronic lymphocytic leukemia/small lymphocytic lymphoma.Part II Ibrutinib treating relapsed and refractory chronic lymphocytic leukemiaObjectives: A significant proportion of chronic lymphocytic leukemia patients relapse after first-line treatment.Currently,treatment of relapsed and refractory chronic lymphocytic leukemia remains a challenge to be overcome.This article explores the efficacy of ibrutinib in treating relapsed and refractory chronic lymphocytic leukemia.Methods: This study retrospectively analyzed the patients with relapsed and refractory chronic lymphocytic leukemia and treated with ibrutinib in Shanghai Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 2014 to December 2017.The patients’ overall response rate to treatment,progression-free survival and overall survival were analyzed.Results: A total of 5 patients were enrolled in this study.Ibrutinib is well-tolerated.Major adverse effects included diarrhea,neutropenia,thrombocytopenia and hypertension.One patient achieved complete remission,and the remaining 4 patients achieved partial remission.With a median follow-up of 32 months,median progression-free survival was 33 months and median overall survival was 38 months.Conclusions: Ibrutinib monotherapy for relapsed and refractory chronic lymphocytic leukemia patients is well tolerated and effective.